Morning Rounds \u00b7 PSM Numericals \u00b7 Round 07<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n#nps07 *,#nps07 *::before,#nps07 *::after{box-sizing:border-box;margin:0;padding:0}\n#nps07{\n --ob:#1A5F7A;--ob-light:#236E8C;--ob-pale:#E6F3F7;--ob-dark:#114455;\n --correct:#2D6B47;--correct-bg:#EAF6EF;--correct-border:#3A9960;\n --wrong:#B83232;--wrong-bg:#FDF0F0;--wrong-border:#E53935;\n --ink:#0F2A35;--ink-mid:#2A4D5A;--ink-soft:#5A7D8A;\n --line:#B8D8E3;--cream:#F2F8FA;--warm:#F8FCFD;\n font-family:'Source Serif 4',Georgia,serif;\n font-size:16px;color:var(--ink);background:var(--cream);\n line-height:1.7;padding:0 0 64px;\n}\n#nps07 .mr-header{background:linear-gradient(135deg,var(--ob-dark) 0%,var(--ob) 60%,var(--ob-light) 100%);color:#E4F4F9;padding:36px 24px 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class=\"mr-series-tag\">Numerical Series · PSM Nutrition<\/div>\n <div class=\"mr-eyebrow\">Morning Rounds · Round 07 of 07<\/div>\n <div class=\"mr-title\">Nutrition Numericals<br><em>Calories, BMI & RDA<\/em><\/div>\n <div class=\"mr-subtitle\">Series finale · Caloric values, energy balance, BMI cut-offs & Indian RDA benchmarks<\/div>\n <div class=\"mr-chips\">\n <span class=\"mr-chip\">5 Questions<\/span>\n <span class=\"mr-chip\">+4 \/ −1 scoring<\/span>\n <span class=\"mr-chip\">Options reshuffled<\/span>\n <\/div>\n <\/div>\n\n <div class=\"mr-sentinel\" id=\"nps07-sentinel\"><\/div>\n\n <div class=\"mr-progress\" id=\"nps07-progress\">\n <div class=\"mr-prog-inner\">\n <div class=\"mr-pips\" id=\"nps07-pips\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"mr-body\">\n <div id=\"nps07-cases\"><\/div>\n <div class=\"mr-submit-wrap\">\n <button class=\"mr-btn\" id=\"nps07-submit\">Submit for Debrief<\/button>\n <\/div>\n <div class=\"mr-score\" id=\"nps07-score\">\n <div class=\"mr-score-in\">\n <div class=\"mr-score-ey\">Series Complete<\/div>\n <div class=\"mr-ring\" id=\"nps07-ring\">\n <div class=\"mr-ring-in\">\n <span class=\"mr-ring-pct\" id=\"nps07-pct\">0%<\/span>\n <span class=\"mr-ring-sub\">net<\/span>\n <\/div>\n <\/div>\n <div class=\"mr-score-title\">Round 07 — Your Debrief<\/div>\n <div class=\"mr-score-net\" id=\"nps07-net\"><\/div>\n <div class=\"mr-verdict\" id=\"nps07-verdict\"><\/div>\n <div class=\"mr-bands\">\n <span class=\"mr-band mr-band-c\" id=\"nps07-ct-c\"><\/span>\n <span class=\"mr-band mr-band-w\" id=\"nps07-ct-w\"><\/span>\n <span class=\"mr-band mr-band-s\" id=\"nps07-ct-s\"><\/span>\n <\/div>\n <button class=\"mr-retry\" id=\"nps07-retry\">↻ Retry This Round<\/button>\n <div class=\"mr-series-end\">\n <strong>All 7 Rounds Complete.<\/strong><br>\n 2×2 table, sensitivity & specificity, PPV & NPV, NNT & risk ratios,\n attack rates & herd immunity, vital statistics, and nutrition numericals.\n The Summative Revision awaits.\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n<\/div>\n\n<script>\n(function () {\n 'use strict';\n\n var NS = 'nps07';\n var TOTAL = 5;\n var MAX = 20;\n var LTRS = ['A','B','C','D'];\n\n var QS = [\n\n {\n id: 1,\n tag: 'Caloric Values — Atwater Factors',\n stem: 'A meal provides <strong>60 g carbohydrate, 20 g protein, and 15 g fat<\/strong>. Using the Atwater general factors, what is the <strong>total caloric value<\/strong> of this meal?',\n correct: '455 kcal',\n opts: [\n '455 kcal',\n '475 kcal',\n '420 kcal',\n '390 kcal'\n ],\n exp: 'Atwater general factors: <strong>carbohydrate = 4 kcal\/g, protein = 4 kcal\/g, fat = 9 kcal\/g<\/strong>. Alcohol = 7 kcal\/g (not needed here).<span class=\"calc\">Carbohydrate: 60 g × 4 = 240 kcal<br>Protein: 20 g × 4 = 80 kcal<br>Fat: 15 g × 9 = 135 kcal<br>Total = 240 + 80 + 135 = <strong>455 kcal<\/strong><\/span>These three numbers — 4, 4, 9 — are the most recalled facts in nutrition numericals and appear in almost every PSM exam. The trap: candidates sometimes use 4 kcal\/g for fat or 9 kcal\/g for protein. Fat yields more than twice the calories per gram of either carbohydrate or protein — this asymmetry drives the logic of low-fat diets and caloric density calculations. Trap 475 kcal uses fat = 9.5. Trap 420 kcal uses protein = 3. Trap 390 kcal uses fat = 8.'\n },\n\n {\n id: 2,\n tag: 'Energy Balance — Weight Loss Calculation',\n stem: 'A sedentary adult requires <strong>2000 kcal\/day<\/strong>. To lose <strong>1 kg of body fat<\/strong>, approximately <strong>7700 kcal<\/strong> must be expended above intake. If this person reduces intake by <strong>500 kcal\/day<\/strong> while keeping activity constant, how many <strong>days<\/strong> will it take to lose 1 kg?',\n correct: '15.4 days; approximately 2 weeks per kilogram at a 500 kcal\/day deficit',\n opts: [\n '15.4 days; approximately 2 weeks per kilogram at a 500 kcal\/day deficit',\n '7.7 days; the deficit compounds so weight loss accelerates after the first week',\n '15.4 days; this calculation assumes fat contains 9 kcal\/g, so 1 kg fat = 9000 kcal',\n '11 days; calculated using 500 kcal deficit against the 2000 kcal daily requirement'\n ],\n exp: '<span class=\"calc\">Days to lose 1 kg = Caloric deficit needed ÷ Daily deficit<br>= 7700 kcal ÷ 500 kcal\/day = <strong>15.4 days<\/strong><\/span>The 7700 kcal figure is the clinical standard for 1 kg of body fat (adipose tissue contains ~87% fat by mass; pure fat = 9 kcal\/g, but adipose tissue also contains water and protein, bringing the effective value to ~7700 kcal\/kg).<br><br>This is also why weight loss is slower than pure arithmetic suggests: a 500 kcal\/day deficit is roughly 1 kg per 2 weeks, or 2 kg per month. The debrief anchor: <strong>500 kcal\/day deficit → ~0.5 kg\/week<\/strong> — a clinically useful rule. Trap B claims the deficit compounds — in a simple linear model it does not; body weight decreases so basal metabolic rate falls, actually slowing loss over time. Trap C misapplies the pure fat caloric value (9 kcal\/g) to give 9000 kcal\/kg — wrong; adipose tissue is not pure fat. Trap D divides 2000 by 500 rather than 7700 by 500.'\n },\n\n {\n id: 3,\n tag: 'BMI — Calculation & Indian Cut-offs',\n stem: 'A 42-year-old Indian man weighs <strong>72 kg<\/strong> and is <strong>168 cm<\/strong> tall. What is his <strong>BMI<\/strong>, and how is he classified using <strong>India-specific WHO cut-offs<\/strong>?',\n correct: '25.5 kg\/m²; classified as overweight by Indian cut-offs (overweight ≥23, obese ≥27.5)',\n opts: [\n '25.5 kg\/m²; classified as overweight by Indian cut-offs (overweight ≥23, obese ≥27.5)',\n '25.5 kg\/m²; classified as normal by standard WHO cut-offs (normal 18.5–24.9)',\n '23.0 kg\/m²; calculated by dividing weight in kg by height in cm squared',\n '25.5 kg\/m²; classified as obese by Indian cut-offs since BMI exceeds 25'\n ],\n exp: 'BMI = <strong>Weight (kg) ÷ Height (m)<sup>2<\/sup><\/strong>.<span class=\"calc\">Height in metres = 168 cm ÷ 100 = 1.68 m<br>BMI = 72 ÷ (1.68)<sup>2<\/sup> = 72 ÷ 2.8224 = <strong>25.51 kg\/m²<\/strong><\/span>Classification using <strong>India-specific cut-offs<\/strong> (WHO Asia-Pacific \/ ICMR):<br>• Underweight: <18.5<br>• Normal: 18.5–22.9<br>• Overweight: 23.0–27.4<br>• Obese: ≥27.5<br><br>Standard WHO cut-offs (Caucasian populations): normal = 18.5–24.9, overweight = 25–29.9, obese = ≥30. At BMI 25.5, this man is <strong>normal by standard WHO but overweight by Indian cut-offs<\/strong> — this distinction is a direct exam question. South Asians develop metabolic complications (diabetes, hypertension, dyslipidaemia) at lower BMI values than Caucasians, which is why India-specific cut-offs are lower. Trap B correctly calculates BMI but applies standard WHO. Trap C uses height in cm directly without conversion. Trap D calls BMI 25.5 obese by Indian cut-offs — obese begins at 27.5, not 25.'\n },\n\n {\n id: 4,\n tag: 'Protein RDA — Calculation for a Pregnant Woman',\n stem: 'The Indian Council of Medical Research (ICMR) recommends <strong>0.8 g protein per kg body weight per day<\/strong> for a sedentary adult woman, with an <strong>additional 23 g\/day during pregnancy<\/strong>. A pregnant woman weighs <strong>55 kg<\/strong>. What is her <strong>total daily protein requirement<\/strong>?',\n correct: '67 g\/day',\n opts: [\n '67 g\/day',\n '78 g\/day',\n '44 g\/day',\n '83 g\/day'\n ],\n exp: '<span class=\"calc\">Base requirement = 0.8 g\/kg × 55 kg = 44 g\/day<br>Pregnancy addition = +23 g\/day<br>Total = 44 + 23 = <strong>67 g\/day<\/strong><\/span>Key ICMR protein benchmarks to memorise:<br>• Sedentary adult man: 0.8 g\/kg\/day (~60 g for 75 kg man)<br>• Sedentary adult woman: 0.8 g\/kg\/day (~44 g for 55 kg woman)<br>• Pregnancy: +23 g\/day<br>• Lactation (0–6 months): +19 g\/day<br><br>Trap 78 g\/day adds 34 g instead of 23 g. Trap 44 g\/day gives only the base, forgetting the pregnancy addition. Trap 83 g\/day uses 1.0 g\/kg (WHO figure, not ICMR) plus 23 g. In exam questions, always check whether they specify ICMR or WHO figures — the base value differs between guidelines and the addition for pregnancy is specific to ICMR NIN recommendations.'\n },\n\n {\n id: 5,\n tag: 'Caloric Distribution — Macronutrient Balance',\n stem: 'A diet provides <strong>2200 kcal\/day<\/strong>. The recommended macronutrient distribution is <strong>60% carbohydrate, 15% protein, 25% fat<\/strong>. What is the required intake in grams for each macronutrient?',\n correct: 'Carbohydrate 330 g, protein 82.5 g, fat 61.1 g',\n opts: [\n 'Carbohydrate 330 g, protein 82.5 g, fat 61.1 g',\n 'Carbohydrate 330 g, protein 82.5 g, fat 55 g',\n 'Carbohydrate 275 g, protein 82.5 g, fat 61.1 g',\n 'Carbohydrate 330 g, protein 75 g, fat 61.1 g'\n ],\n exp: 'Convert percentage of total calories to grams using Atwater factors (CHO=4, protein=4, fat=9).<span class=\"calc\">Carbohydrate: 60% × 2200 = 1320 kcal ÷ 4 = <strong>330 g<\/strong><br>Protein: 15% × 2200 = 330 kcal ÷ 4 = <strong>82.5 g<\/strong><br>Fat: 25% × 2200 = 550 kcal ÷ 9 = <strong>61.1 g<\/strong><\/span>This three-step calculation — percentage → kcal → grams — is the standard method and appears regularly in PSM exams. The fat calculation is where candidates err: dividing fat kcal by 4 (like carbohydrate) gives 137.5 g, an answer that appears nowhere but arises from that specific error. Dividing by 9 is the only correct step for fat.<br><br>Trap B uses fat = 9.2 or some variant giving 55 g. Trap C calculates carbohydrate kcal as 55% instead of 60%, giving 275 g. Trap D uses protein = 3.5 kcal\/g giving 75 g. Always: percentage × total kcal = macronutrient kcal, then divide by the correct Atwater factor for that macronutrient.'\n }\n\n ];\n\n var answers = {}, answered = 0, shuffled = {}, done = false;\n\n function gid(s) { return document.getElementById(NS + '-' + s); }\n function byId(s) { return document.getElementById(s); }\n\n function shuffleArr(arr) {\n var a = arr.slice(), i, j, t;\n for (i = a.length - 1; i > 0; i--) {\n j = Math.floor(Math.random() * (i + 1));\n t = a[i]; a[i] = a[j]; a[j] = t;\n }\n return a;\n }\n\n function countVal(v) {\n var n = 0, k;\n for (k in answers) { if (answers[k] === v) n++; }\n return n;\n }\n\n function buildPips() {\n var cont = gid('pips'), i, q, wLine, wPip, line, pip;\n cont.innerHTML = '';\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n if (i > 0) {\n wLine = document.createElement('div');\n wLine.className = 'mr-pip-wrap';\n line = document.createElement('div');\n line.className = 'mr-pip-line';\n line.id = NS + '-pl' + q.id;\n wLine.appendChild(line);\n cont.appendChild(wLine);\n }\n wPip = document.createElement('div');\n wPip.className = 'mr-pip-wrap';\n pip = document.createElement('div');\n pip.className = 'mr-pip';\n pip.id = NS + '-pip' + q.id;\n pip.textContent = String(q.id);\n wPip.appendChild(pip);\n cont.appendChild(wPip);\n }\n }\n\n function build() {\n var cont, i, q, opts, card, top, numDiv, meta, tag, stem,\n rule, optsDiv, expDiv, lbl, txt, j, optEl, ltrSpan, txtSpan;\n\n cont = gid('cases');\n cont.innerHTML = '';\n answers = {}; answered = 0; shuffled = {}; done = false;\n gid('score').style.display = 'none';\n buildPips();\n\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n opts = shuffleArr(q.opts);\n shuffled[q.id] = opts;\n\n card = document.createElement('div');\n card.className = 'mr-case';\n\n top = document.createElement('div');\n top.className = 'mr-case-top';\n\n numDiv = document.createElement('div');\n numDiv.className = 'mr-num';\n numDiv.textContent = q.id < 10 ? '0' + q.id : String(q.id);\n\n meta = document.createElement('div');\n meta.className = 'mr-meta';\n\n tag = document.createElement('div');\n tag.className = 'mr-tag';\n tag.innerHTML = q.tag;\n\n stem = document.createElement('div');\n stem.className = 'mr-stem';\n stem.innerHTML = q.stem;\n\n meta.appendChild(tag);\n meta.appendChild(stem);\n top.appendChild(numDiv);\n top.appendChild(meta);\n card.appendChild(top);\n\n rule = document.createElement('div');\n rule.className = 'mr-rule';\n card.appendChild(rule);\n\n optsDiv = document.createElement('div');\n optsDiv.className = 'mr-opts';\n\n for (j = 0; j < opts.length; j++) {\n optEl = document.createElement('div');\n optEl.className = 'mr-opt';\n optEl.id = NS + '-o' + q.id + '-' + j;\n optEl.setAttribute('role', 'button');\n optEl.setAttribute('tabindex', '0');\n\n ltrSpan = document.createElement('span');\n ltrSpan.className = 'mr-ltr';\n ltrSpan.textContent = LTRS[j];\n\n txtSpan = document.createElement('span');\n txtSpan.className = 'mr-opt-text';\n txtSpan.innerHTML = opts[j];\n\n optEl.appendChild(ltrSpan);\n optEl.appendChild(txtSpan);\n optsDiv.appendChild(optEl);\n\n (function (qid, oi) {\n optEl.addEventListener('click', function () { pick(qid, oi); });\n }(q.id, j));\n }\n card.appendChild(optsDiv);\n\n expDiv = document.createElement('div');\n expDiv.className = 'mr-exp';\n expDiv.id = NS + '-exp' + q.id;\n\n lbl = document.createElement('div');\n lbl.className = 'mr-exp-lbl';\n lbl.textContent = 'Debrief';\n\n txt = document.createElement('div');\n txt.className = 'mr-exp-text';\n txt.innerHTML = q.exp;\n\n expDiv.appendChild(lbl);\n expDiv.appendChild(txt);\n card.appendChild(expDiv);\n cont.appendChild(card);\n }\n }\n\n function pick(qid, oi) {\n var q, opts, i, el, correct;\n if (answers[qid] !== undefined || done) return;\n\n q = null;\n for (i = 0; i < QS.length; i++) {\n if (QS[i].id === qid) { q = QS[i]; break; }\n }\n if (!q) return;\n\n opts = shuffled[qid];\n correct = (opts[oi] === q.correct);\n answers[qid] = correct ? 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'correct' : 'wrong');\n\n if (qid > 1) {\n var pl = byId(NS + '-pl' + qid);\n if (pl) { pl.className = 'mr-pip-line done'; }\n }\n }\n\n function showScore() {\n var c, w, s, net, pct, disp, verdicts, vi, sc;\n if (done) return;\n done = true;\n\n c = countVal('c');\n w = countVal('w');\n s = TOTAL - answered;\n net = (c * 4) - w;\n pct = Math.max(0, Math.round((net \/ MAX) * 100));\n disp = Math.min(100, Math.max(0, pct));\n\n gid('ring').style.background =\n 'conic-gradient(#1A5F7A ' + disp + '%, #B8D8E3 0%)';\n\n gid('pct').textContent = pct + '%';\n gid('net').textContent = 'Net Score: ' + net + ' \/ ' + MAX;\n\n verdicts = [\n [5, 'Flawless. Atwater factors, BMI Indian cut-offs, ICMR protein RDA, macronutrient distribution \\u2014 all cold.'],\n [4, 'Strong series finish. One formula to consolidate \\u2014 the debrief has it.'],\n [3, 'Good base. 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.mr-score-net{font-size:0.9rem;color:var(--ob);font-weight:600;margin-bottom:4px}\n#nps07 .mr-verdict{font-size:0.83rem;color:var(--ink-soft);font-style:italic;margin-bottom:18px;padding:0 12px}\n#nps07 .mr-bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap}\n#nps07 .mr-band{padding:5px 13px;border-radius:16px;font-size:0.78rem;font-weight:600}\n#nps07 .mr-band-c{background:var(--correct-bg);color:var(--correct)}\n#nps07 .mr-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#nps07 .mr-band-s{background:var(--ob-pale);color:var(--ob)}\n#nps07 .mr-retry{display:block;margin:18px auto 4px;background:transparent;border:2px solid var(--ob);color:var(--ob);border-radius:8px;padding:9px 28px;font-family:'Playfair Display',serif;font-size:0.92rem;font-weight:700;cursor:pointer;}\n#nps07 .mr-retry:hover{background:var(--ob);color:#E4F4F9}\n#nps07 .mr-series-end{text-align:center;padding:24px 16px 0;font-size:0.86rem;color:var(--ink-soft);font-style:italic;border-top:1px solid var(--line);margin-top:8px;}\n#nps07 .mr-series-end strong{color:var(--ob);font-style:normal;}\n@media(max-width:480px){\n #nps07 .mr-title{font-size:1.4rem}\n #nps07 .mr-num{font-size:1.7rem}\n #nps07 .mr-stem{font-size:0.9rem}\n #nps07 .mr-opt-text{font-size:0.86rem}\n}\n<\/style>\n\n<div id=\"nps07\">\n\n <div class=\"mr-header\">\n <div class=\"mr-series-tag\">Numerical Series · PSM Nutrition<\/div>\n <div class=\"mr-eyebrow\">Morning Rounds · Round 07 of 07<\/div>\n <div class=\"mr-title\">Nutrition Numericals<br><em>Calories, BMI & RDA<\/em><\/div>\n <div class=\"mr-subtitle\">Series finale · Caloric values, energy balance, BMI cut-offs & Indian RDA benchmarks<\/div>\n <div class=\"mr-chips\">\n <span class=\"mr-chip\">5 Questions<\/span>\n <span class=\"mr-chip\">+4 \/ −1 scoring<\/span>\n <span class=\"mr-chip\">Options reshuffled<\/span>\n <\/div>\n <\/div>\n\n <div class=\"mr-sentinel\" id=\"nps07-sentinel\"><\/div>\n\n <div class=\"mr-progress\" id=\"nps07-progress\">\n <div class=\"mr-prog-inner\">\n <div class=\"mr-pips\" id=\"nps07-pips\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"mr-body\">\n <div id=\"nps07-cases\"><\/div>\n <div class=\"mr-submit-wrap\">\n <button class=\"mr-btn\" id=\"nps07-submit\">Submit for Debrief<\/button>\n <\/div>\n <div class=\"mr-score\" id=\"nps07-score\">\n <div class=\"mr-score-in\">\n <div class=\"mr-score-ey\">Series Complete<\/div>\n <div class=\"mr-ring\" id=\"nps07-ring\">\n <div class=\"mr-ring-in\">\n <span class=\"mr-ring-pct\" id=\"nps07-pct\">0%<\/span>\n <span class=\"mr-ring-sub\">net<\/span>\n <\/div>\n <\/div>\n <div class=\"mr-score-title\">Round 07 — Your Debrief<\/div>\n <div class=\"mr-score-net\" id=\"nps07-net\"><\/div>\n <div class=\"mr-verdict\" id=\"nps07-verdict\"><\/div>\n <div class=\"mr-bands\">\n <span class=\"mr-band mr-band-c\" id=\"nps07-ct-c\"><\/span>\n <span class=\"mr-band mr-band-w\" id=\"nps07-ct-w\"><\/span>\n <span class=\"mr-band mr-band-s\" id=\"nps07-ct-s\"><\/span>\n <\/div>\n <button class=\"mr-retry\" id=\"nps07-retry\">↻ Retry This Round<\/button>\n <div class=\"mr-series-end\">\n <strong>All 7 Rounds Complete.<\/strong><br>\n 2×2 table, sensitivity & specificity, PPV & NPV, NNT & risk ratios,\n attack rates & herd immunity, vital statistics, and nutrition numericals.\n The Summative Revision awaits.\n <\/div>\n <\/div>\n <\/div>\n <\/div>\n\n<\/div>\n\n<script>\n(function () {\n 'use strict';\n\n var NS = 'nps07';\n var TOTAL = 5;\n var MAX = 20;\n var LTRS = ['A','B','C','D'];\n\n var QS = [\n\n {\n id: 1,\n tag: 'Caloric Values — Atwater Factors',\n stem: 'A meal provides <strong>60 g carbohydrate, 20 g protein, and 15 g fat<\/strong>. Using the Atwater general factors, what is the <strong>total caloric value<\/strong> of this meal?',\n correct: '455 kcal',\n opts: [\n '455 kcal',\n '475 kcal',\n '420 kcal',\n '390 kcal'\n ],\n exp: 'Atwater general factors: <strong>carbohydrate = 4 kcal\/g, protein = 4 kcal\/g, fat = 9 kcal\/g<\/strong>. Alcohol = 7 kcal\/g (not needed here).<span class=\"calc\">Carbohydrate: 60 g × 4 = 240 kcal<br>Protein: 20 g × 4 = 80 kcal<br>Fat: 15 g × 9 = 135 kcal<br>Total = 240 + 80 + 135 = <strong>455 kcal<\/strong><\/span>These three numbers — 4, 4, 9 — are the most recalled facts in nutrition numericals and appear in almost every PSM exam. The trap: candidates sometimes use 4 kcal\/g for fat or 9 kcal\/g for protein. Fat yields more than twice the calories per gram of either carbohydrate or protein — this asymmetry drives the logic of low-fat diets and caloric density calculations. Trap 475 kcal uses fat = 9.5. Trap 420 kcal uses protein = 3. Trap 390 kcal uses fat = 8.'\n },\n\n {\n id: 2,\n tag: 'Energy Balance — Weight Loss Calculation',\n stem: 'A sedentary adult requires <strong>2000 kcal\/day<\/strong>. To lose <strong>1 kg of body fat<\/strong>, approximately <strong>7700 kcal<\/strong> must be expended above intake. If this person reduces intake by <strong>500 kcal\/day<\/strong> while keeping activity constant, how many <strong>days<\/strong> will it take to lose 1 kg?',\n correct: '15.4 days; approximately 2 weeks per kilogram at a 500 kcal\/day deficit',\n opts: [\n '15.4 days; approximately 2 weeks per kilogram at a 500 kcal\/day deficit',\n '7.7 days; the deficit compounds so weight loss accelerates after the first week',\n '15.4 days; this calculation assumes fat contains 9 kcal\/g, so 1 kg fat = 9000 kcal',\n '11 days; calculated using 500 kcal deficit against the 2000 kcal daily requirement'\n ],\n exp: '<span class=\"calc\">Days to lose 1 kg = Caloric deficit needed ÷ Daily deficit<br>= 7700 kcal ÷ 500 kcal\/day = <strong>15.4 days<\/strong><\/span>The 7700 kcal figure is the clinical standard for 1 kg of body fat (adipose tissue contains ~87% fat by mass; pure fat = 9 kcal\/g, but adipose tissue also contains water and protein, bringing the effective value to ~7700 kcal\/kg).<br><br>This is also why weight loss is slower than pure arithmetic suggests: a 500 kcal\/day deficit is roughly 1 kg per 2 weeks, or 2 kg per month. The debrief anchor: <strong>500 kcal\/day deficit → ~0.5 kg\/week<\/strong> — a clinically useful rule. Trap B claims the deficit compounds — in a simple linear model it does not; body weight decreases so basal metabolic rate falls, actually slowing loss over time. Trap C misapplies the pure fat caloric value (9 kcal\/g) to give 9000 kcal\/kg — wrong; adipose tissue is not pure fat. Trap D divides 2000 by 500 rather than 7700 by 500.'\n },\n\n {\n id: 3,\n tag: 'BMI — Calculation & Indian Cut-offs',\n stem: 'A 42-year-old Indian man weighs <strong>72 kg<\/strong> and is <strong>168 cm<\/strong> tall. What is his <strong>BMI<\/strong>, and how is he classified using <strong>India-specific WHO cut-offs<\/strong>?',\n correct: '25.5 kg\/m²; classified as overweight by Indian cut-offs (overweight ≥23, obese ≥27.5)',\n opts: [\n '25.5 kg\/m²; classified as overweight by Indian cut-offs (overweight ≥23, obese ≥27.5)',\n '25.5 kg\/m²; classified as normal by standard WHO cut-offs (normal 18.5–24.9)',\n '23.0 kg\/m²; calculated by dividing weight in kg by height in cm squared',\n '25.5 kg\/m²; classified as obese by Indian cut-offs since BMI exceeds 25'\n ],\n exp: 'BMI = <strong>Weight (kg) ÷ Height (m)<sup>2<\/sup><\/strong>.<span class=\"calc\">Height in metres = 168 cm ÷ 100 = 1.68 m<br>BMI = 72 ÷ (1.68)<sup>2<\/sup> = 72 ÷ 2.8224 = <strong>25.51 kg\/m²<\/strong><\/span>Classification using <strong>India-specific cut-offs<\/strong> (WHO Asia-Pacific \/ ICMR):<br>• Underweight: <18.5<br>• Normal: 18.5–22.9<br>• Overweight: 23.0–27.4<br>• Obese: ≥27.5<br><br>Standard WHO cut-offs (Caucasian populations): normal = 18.5–24.9, overweight = 25–29.9, obese = ≥30. At BMI 25.5, this man is <strong>normal by standard WHO but overweight by Indian cut-offs<\/strong> — this distinction is a direct exam question. South Asians develop metabolic complications (diabetes, hypertension, dyslipidaemia) at lower BMI values than Caucasians, which is why India-specific cut-offs are lower. Trap B correctly calculates BMI but applies standard WHO. Trap C uses height in cm directly without conversion. Trap D calls BMI 25.5 obese by Indian cut-offs — obese begins at 27.5, not 25.'\n },\n\n {\n id: 4,\n tag: 'Protein RDA — Calculation for a Pregnant Woman',\n stem: 'The Indian Council of Medical Research (ICMR) recommends <strong>0.8 g protein per kg body weight per day<\/strong> for a sedentary adult woman, with an <strong>additional 23 g\/day during pregnancy<\/strong>. A pregnant woman weighs <strong>55 kg<\/strong>. What is her <strong>total daily protein requirement<\/strong>?',\n correct: '67 g\/day',\n opts: [\n '67 g\/day',\n '78 g\/day',\n '44 g\/day',\n '83 g\/day'\n ],\n exp: '<span class=\"calc\">Base requirement = 0.8 g\/kg × 55 kg = 44 g\/day<br>Pregnancy addition = +23 g\/day<br>Total = 44 + 23 = <strong>67 g\/day<\/strong><\/span>Key ICMR protein benchmarks to memorise:<br>• Sedentary adult man: 0.8 g\/kg\/day (~60 g for 75 kg man)<br>• Sedentary adult woman: 0.8 g\/kg\/day (~44 g for 55 kg woman)<br>• Pregnancy: +23 g\/day<br>• Lactation (0–6 months): +19 g\/day<br><br>Trap 78 g\/day adds 34 g instead of 23 g. Trap 44 g\/day gives only the base, forgetting the pregnancy addition. Trap 83 g\/day uses 1.0 g\/kg (WHO figure, not ICMR) plus 23 g. In exam questions, always check whether they specify ICMR or WHO figures — the base value differs between guidelines and the addition for pregnancy is specific to ICMR NIN recommendations.'\n },\n\n {\n id: 5,\n tag: 'Caloric Distribution — Macronutrient Balance',\n stem: 'A diet provides <strong>2200 kcal\/day<\/strong>. The recommended macronutrient distribution is <strong>60% carbohydrate, 15% protein, 25% fat<\/strong>. What is the required intake in grams for each macronutrient?',\n correct: 'Carbohydrate 330 g, protein 82.5 g, fat 61.1 g',\n opts: [\n 'Carbohydrate 330 g, protein 82.5 g, fat 61.1 g',\n 'Carbohydrate 330 g, protein 82.5 g, fat 55 g',\n 'Carbohydrate 275 g, protein 82.5 g, fat 61.1 g',\n 'Carbohydrate 330 g, protein 75 g, fat 61.1 g'\n ],\n exp: 'Convert percentage of total calories to grams using Atwater factors (CHO=4, protein=4, fat=9).<span class=\"calc\">Carbohydrate: 60% × 2200 = 1320 kcal ÷ 4 = <strong>330 g<\/strong><br>Protein: 15% × 2200 = 330 kcal ÷ 4 = <strong>82.5 g<\/strong><br>Fat: 25% × 2200 = 550 kcal ÷ 9 = <strong>61.1 g<\/strong><\/span>This three-step calculation — percentage → kcal → grams — is the standard method and appears regularly in PSM exams. The fat calculation is where candidates err: dividing fat kcal by 4 (like carbohydrate) gives 137.5 g, an answer that appears nowhere but arises from that specific error. Dividing by 9 is the only correct step for fat.<br><br>Trap B uses fat = 9.2 or some variant giving 55 g. Trap C calculates carbohydrate kcal as 55% instead of 60%, giving 275 g. Trap D uses protein = 3.5 kcal\/g giving 75 g. Always: percentage × total kcal = macronutrient kcal, then divide by the correct Atwater factor for that macronutrient.'\n }\n\n ];\n\n var answers = {}, answered = 0, shuffled = {}, done = false;\n\n function gid(s) { return document.getElementById(NS + '-' + s); }\n function byId(s) { return document.getElementById(s); }\n\n function shuffleArr(arr) {\n var a = arr.slice(), i, j, t;\n for (i = a.length - 1; i > 0; i--) {\n j = Math.floor(Math.random() * (i + 1));\n t = a[i]; a[i] = a[j]; a[j] = t;\n }\n return a;\n }\n\n function countVal(v) {\n var n = 0, k;\n for (k in answers) { if (answers[k] === v) n++; }\n return n;\n }\n\n function buildPips() {\n var cont = gid('pips'), i, q, wLine, wPip, line, pip;\n cont.innerHTML = '';\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n if (i > 0) {\n wLine = document.createElement('div');\n wLine.className = 'mr-pip-wrap';\n line = document.createElement('div');\n line.className = 'mr-pip-line';\n line.id = NS + '-pl' + q.id;\n wLine.appendChild(line);\n cont.appendChild(wLine);\n }\n wPip = document.createElement('div');\n wPip.className = 'mr-pip-wrap';\n pip = document.createElement('div');\n pip.className = 'mr-pip';\n pip.id = NS + '-pip' + q.id;\n pip.textContent = String(q.id);\n wPip.appendChild(pip);\n cont.appendChild(wPip);\n }\n }\n\n function build() {\n var cont, i, q, opts, card, top, numDiv, meta, tag, stem,\n rule, optsDiv, expDiv, lbl, txt, j, optEl, ltrSpan, txtSpan;\n\n cont = gid('cases');\n cont.innerHTML = '';\n answers = {}; answered = 0; shuffled = {}; done = false;\n gid('score').style.display = 'none';\n buildPips();\n\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n opts = shuffleArr(q.opts);\n shuffled[q.id] = opts;\n\n card = document.createElement('div');\n card.className = 'mr-case';\n\n top = document.createElement('div');\n top.className = 'mr-case-top';\n\n numDiv = document.createElement('div');\n numDiv.className = 'mr-num';\n numDiv.textContent = q.id < 10 ? '0' + q.id : String(q.id);\n\n meta = document.createElement('div');\n meta.className = 'mr-meta';\n\n tag = document.createElement('div');\n tag.className = 'mr-tag';\n tag.innerHTML = q.tag;\n\n stem = document.createElement('div');\n stem.className = 'mr-stem';\n stem.innerHTML = q.stem;\n\n meta.appendChild(tag);\n meta.appendChild(stem);\n top.appendChild(numDiv);\n top.appendChild(meta);\n card.appendChild(top);\n\n rule = document.createElement('div');\n rule.className = 'mr-rule';\n card.appendChild(rule);\n\n optsDiv = document.createElement('div');\n optsDiv.className = 'mr-opts';\n\n for (j = 0; j < opts.length; j++) {\n optEl = document.createElement('div');\n optEl.className = 'mr-opt';\n optEl.id = NS + '-o' + q.id + '-' + j;\n optEl.setAttribute('role', 'button');\n optEl.setAttribute('tabindex', '0');\n\n ltrSpan = document.createElement('span');\n ltrSpan.className = 'mr-ltr';\n ltrSpan.textContent = LTRS[j];\n\n txtSpan = document.createElement('span');\n txtSpan.className = 'mr-opt-text';\n txtSpan.innerHTML = opts[j];\n\n optEl.appendChild(ltrSpan);\n optEl.appendChild(txtSpan);\n optsDiv.appendChild(optEl);\n\n (function (qid, oi) {\n optEl.addEventListener('click', function () { pick(qid, oi); });\n }(q.id, j));\n }\n card.appendChild(optsDiv);\n\n expDiv = document.createElement('div');\n expDiv.className = 'mr-exp';\n expDiv.id = NS + '-exp' + q.id;\n\n lbl = document.createElement('div');\n lbl.className = 'mr-exp-lbl';\n lbl.textContent = 'Debrief';\n\n txt = document.createElement('div');\n txt.className = 'mr-exp-text';\n txt.innerHTML = q.exp;\n\n expDiv.appendChild(lbl);\n expDiv.appendChild(txt);\n card.appendChild(expDiv);\n cont.appendChild(card);\n }\n }\n\n function pick(qid, oi) {\n var q, opts, i, el, correct;\n if (answers[qid] !== undefined || done) return;\n\n q = null;\n for (i = 0; i < QS.length; i++) {\n if (QS[i].id === qid) { q = QS[i]; break; }\n }\n if (!q) return;\n\n opts = shuffled[qid];\n correct = (opts[oi] === q.correct);\n answers[qid] = correct ? 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'correct' : 'wrong');\n\n if (qid > 1) {\n var pl = byId(NS + '-pl' + qid);\n if (pl) { pl.className = 'mr-pip-line done'; }\n }\n }\n\n function showScore() {\n var c, w, s, net, pct, disp, verdicts, vi, sc;\n if (done) return;\n done = true;\n\n c = countVal('c');\n w = countVal('w');\n s = TOTAL - answered;\n net = (c * 4) - w;\n pct = Math.max(0, Math.round((net \/ MAX) * 100));\n disp = Math.min(100, Math.max(0, pct));\n\n gid('ring').style.background =\n 'conic-gradient(#1A5F7A ' + disp + '%, #B8D8E3 0%)';\n\n gid('pct').textContent = pct + '%';\n gid('net').textContent = 'Net Score: ' + net + ' \/ ' + MAX;\n\n verdicts = [\n [5, 'Flawless. Atwater factors, BMI Indian cut-offs, ICMR protein RDA, macronutrient distribution \\u2014 all cold.'],\n [4, 'Strong series finish. One formula to consolidate \\u2014 the debrief has it.'],\n [3, 'Good base. 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